United States: Food For Thought (And Health): Day 2 Notes From The JP Morgan Healthcare Conference

Addressing the Social Determinants of
Health: Is the healthcare industry pushing a rock up
a hill? We collectively are trying to provide healthcare with
improved quality and reduced cost, but the structure of the
nation's healthcare system remains heavily siloed with the
social determinants of health often falling wholly or partly
outside the mandate and reach of the healthcare delivery system.
Bernard Tyson of Kaiser on Monday noted studies that health is
determined approximately 30% by family history and genetics, with
the majority of the healthcare impact coming approximately 40% from
personal behavior, 20% from environmental factors and 10% from
healthcare services. So, the playing field, if the above
numbers are correct, is tilted much more toward nurture, rather
than nature. While we are aware of some hospitals starting to
provide housing or other limited services to address the needs of
their community and therefore also to address healthcare cost
containment, those examples are the exception to date, rather than
the rule.

David Feinberg of Geisinger (approximately 2 years now at
Geisinger after his earlier stint at UCLA and UC Health) shared
with the conference attendees several interesting initiatives that
provide a more holistic approach. First, as to genetics, Geisinger
is starting to do full DNA sequencing on some of its patients, with
about 150,000 patients (out of a one million target)
completed. Geisinger is finding about 3-4% of the sequenced
patients with medically actionable results that can be addressed
and benefit the patient. Their protocol after the sequencing
results are available is to send the results to the patient's
primary care physician (PCP) along with an asynchronous medical
education opportunity for the PCP to refresh on the relevant
condition. Five days after the PCP is alerted, the patient is
notified that there was a positive result and invited to meet with
the PCP and a genetic counselor to begin to plan management and
treatment as needed. Interestingly, Geisinger is finding that
for each positive result found, they are receiving approximately
six new patients – people who have heard about the results of
the genetic testing and want to be included in this approach.
A 3-4% actionable percentage can be significant in controlling
healthcare costs, but is this realistic in a different market?
Geisinger has both a health plan and healthcare delivery system,
plus they are not subject to quite the same level of competition as
we can find in other urban markets. But, in evaluating this,
keep in mind the July 2016 Department of Health and Human Services
finding that approximately 5% of the U.S. population accounts for
almost 50% of healthcare spending. So, in that light, is an
investment in genome sequencing an investment in the "public
commons" of healthcare that will benefit everyone?

As to the "nurture" side of the health equation,
Geisinger has launched Springboard Health to address the social
determinants of health. With an initial effort in the
Scranton, Pennsylvania area, selected participants are provided
with food to both address food insecurity and to use the approach
of "food as medicine" through a fresh food
pharmacy. Participants receive healthy food for themselves
and their family, such as vegetables and fruits for diabetic
patients that were not purchasing such themselves. Initial
results are indicating that the food initiatives can be powerful,
with diabetic level improvements potentially resulting in at least
$8,000 per year healthcare cost reductions for health plan
participants. Other aspects of the Springboard approach include
genome sequencing (as noted above), informatics and big data
initiatives, and the use of technology to better connect patients
to social services offerings. While the initial launch is
small in sample size, it will be interesting to watch the
results.

Of course, this type of initiative works best in an integrated
healthcare environment, especially where there is an aligned health
plan and healthcare delivery system, such as we find with Geisinger
and Kaiser, but also what many hospital systems around the country
are targeting as they launch or grow provider-sponsored health
plans.

Medicare Advantage – Growth in
Plans: The Medicare Advantage field will become more
crowded in the next two to three years. In discussions at the
conference, there is strong interest in commencing or expanding
Medicare Advantage health plan business. A number of health systems
and other healthcare organizations are looking to start or expand
provider sponsored health plans. Centene noted that they had
made initial filings to commence Medicare Advantage health plans in
eleven new states. Molina's purchase transaction with
Aetna and Humana for Medicare Advantage contracts in 21 states is
pending the outcome of the antitrust trial. We also note the
increasing number of support organizations who can provide partial
or more complete administrative services and support to Medicare
Advantage plans, including the new launch by Blue Cross of Michigan
and existing offerings from Lumeris, Evolent and Alignment, among
others. We expect to see much more activity in Medicare
Advantage in the next three years, and it is welcome as we move
toward almost doubling of the eligible senior population as the
Baby Boomers continue to age in.

Physician Compensation: As part of the
continuing move toward risk, shared savings and population health
management, we are seeing reevaluation and adjustment of physician
compensation models. This is a topic by itself for further
exploration, but many hospital systems with employed physician
bases are now considering how best to align and incentivize
physicians. It is not an easy question (especially when
connected to the question of operating faculty practice plans at
academic medical centers or physician networks of independent
community physicians), but it is critical to the success of the
other initiatives under way. Presence Health in Chicago noted
their desire to double their medical group in the next three years
while engaging fully their associates. Geisinger has launched
a new physician compensation model that pegs a base of 50th
percentile compensation for all of their employed physicians, which
then can vary upward based upon productivity and patient
satisfaction. This effort in part was intended to address
physician turnover issues. An interesting side note –
Geisinger now is putting on their website their physician rankings
and patient reviews, including the negative reviews.
Effectively, this puts the patient into a "secret
shopper" role and hopefully results in a better patient
experience. Will this increase or decrease physician
turnover, satisfaction and productivity? It will be
interesting to watch.

Branding: A consistent theme with
hospital systems was the importance of branding and brand
investment. We heard over and over again the millions of dollars
being invested into brand. This obviously goes hand in hand
with expansion, attempts to ultimately lower the cost of patient
acquisition and increasing competition. It's a lot of
dollars being spent – we would like to see whether there will
be quantification of the results obtained. That said, healthcare is
one of the most underbranded industries. In almost any other
industry, you can easily name 2-5 leading brands that are national
and respected. That hasn't happened yet at a national scale in
healthcare, but we certainly are seeing the stage being set for
that.

The content of this article is intended to provide a general
guide to the subject matter. Specialist advice should be sought
about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

P.S.R. is the only event that brings you the best of privacy and security in one brilliant (and completely unique) cross-industry conference. And this year, we’re heading to San Diego with even more programming. The main conference now begins on Monday evening, 5 p.m. sharp, with Monday General Session—right after training and workshops end.

This unique, interactive data breach simulation will help you prepare your company for a breach. We will address how to handle tricky legal notice situations and multijurisdictional notice law by walking through a step-by-step experience of a breach.

What you’ll take away:

The immediate steps to take when presented with a potential data breach

Why legal should be involved in the process, and how they should be involved

Familiarity with a full breach episode and how to handle it while lowering the organization's risk and exposure

Covering topics such as promotions and sweepstakes, mobile advertising challenges, privacy considerations, claim substantiation and more, this expansive program will equip you with the tools you need to practice advertising law today.

Please join us for Sheppard Mullin's Labor & Employment Law Update & Happy Hour Seminar Series. 2017 presents significant developments in California labor and employment laws that will affect the way you run your day-to-day business operations. We will provide analysis and insight on these new laws, as well as offer practical advice and helpful tools for employers to protect their organizations from liability in the workplace.

This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).

Email Address

Company Name

Password

Confirm Password

Position

Mondaq Topics -- Select your Interests

Accounting

Anti-trust

Commercial

Compliance

Consumer

Criminal

Employment

Energy

Environment

Family

Finance

Government

Healthcare

Immigration

Insolvency

Insurance

International

IP

Law Performance

Law Practice

Litigation

Media & IT

Privacy

Real Estate

Strategy

Tax

Technology

Transport

Wealth Mgt

Regions

Africa

Asia

Asia Pacific

Australasia

Canada

Caribbean

Europe

European Union

Latin America

Middle East

U.K.

United States

Worldwide Updates

Check to state you have read and agree to our Terms and Conditions

Terms & Conditions and Privacy Statement

Mondaq.com (the Website) is owned and managed by Mondaq Ltd and as a user you
are granted a non-exclusive, revocable license to access the Website under its
terms and conditions of use. Your use of the Website constitutes your agreement
to the following terms and conditions of use. Mondaq Ltd may terminate your use
of the Website if you are in breach of these terms and conditions or if Mondaq
Ltd decides to terminate your license of use for whatever reason.

Use of www.mondaq.com

You may use the Website but are required to register as a user if you wish to
read the full text of the content and articles available (the Content). You may
not modify, publish, transmit, transfer or sell, reproduce, create derivative
works from, distribute, perform, link, display, or in any way exploit any of the
Content, in whole or in part, except as expressly permitted in these terms &
conditions or with the prior written consent of Mondaq Ltd. You may not use
electronic or other means to extract details or information about Mondaq.com’s
content, users or contributors in order to offer them any services or products
which compete directly or indirectly with Mondaq Ltd’s services and products.

Disclaimer

Mondaq Ltd and/or its respective suppliers make no representations about the
suitability of the information contained in the documents and related graphics
published on this server for any purpose. All such documents and related
graphics are provided "as is" without warranty of any kind. Mondaq Ltd and/or
its respective suppliers hereby disclaim all warranties and conditions with
regard to this information, including all implied warranties and conditions of
merchantability, fitness for a particular purpose, title and non-infringement.
In no event shall Mondaq Ltd and/or its respective suppliers be liable for any
special, indirect or consequential damages or any damages whatsoever resulting
from loss of use, data or profits, whether in an action of contract, negligence
or other tortious action, arising out of or in connection with the use or
performance of information available from this server.

The documents and related graphics published on this server could include
technical inaccuracies or typographical errors. Changes are periodically added
to the information herein. Mondaq Ltd and/or its respective suppliers may make
improvements and/or changes in the product(s) and/or the program(s) described
herein at any time.

Registration

Mondaq Ltd requires you to register and provide information that personally
identifies you, including what sort of information you are interested in, for
three primary purposes:

To allow you to personalize the Mondaq websites you are visiting.

To enable features such as password reminder, newsletter alerts, email a
colleague, and linking from Mondaq (and its affiliate sites) to your website.

Mondaq (and its affiliate sites) do not sell or provide your details to third
parties other than information providers. The reason we provide our information
providers with this information is so that they can measure the response their
articles are receiving and provide you with information about their products and
services.

If you do not want us to provide your name and email address you may opt out
by clicking here .

If you do not wish to receive any future announcements of products and
services offered by Mondaq by clicking here .

Information Collection and Use

We require site users to register with Mondaq (and its affiliate sites) to
view the free information on the site. We also collect information from our
users at several different points on the websites: this is so that we can
customise the sites according to individual usage, provide 'session-aware'
functionality, and ensure that content is acquired and developed appropriately.
This gives us an overall picture of our user profiles, which in turn shows to
our Editorial Contributors the type of person they are reaching by posting
articles on Mondaq (and its affiliate sites) – meaning more free content for
registered users.

We are only able to provide the material on the Mondaq (and its affiliate
sites) site free to site visitors because we can pass on information about the
pages that users are viewing and the personal information users provide to us
(e.g. email addresses) to reputable contributing firms such as law firms who
author those pages. We do not sell or rent information to anyone else other than
the authors of those pages, who may change from time to time. Should you wish us
not to disclose your details to any of these parties, please tick the box above
or tick the box marked "Opt out of Registration Information Disclosure" on the
Your Profile page. We and our author organisations may only contact you via
email or other means if you allow us to do so. Users can opt out of contact when
they register on the site, or send an email to unsubscribe@mondaq.com with “no
disclosure” in the subject heading

Mondaq News Alerts

In order to receive Mondaq News Alerts, users have to complete a separate
registration form. This is a personalised service where users choose regions and
topics of interest and we send it only to those users who have requested it.
Users can stop receiving these Alerts by going to the Mondaq News Alerts page
and deselecting all interest areas. In the same way users can amend their
personal preferences to add or remove subject areas.

Cookies

A cookie is a small text file written to a user’s hard drive that contains an
identifying user number. The cookies do not contain any personal information
about users. We use the cookie so users do not have to log in every time they
use the service and the cookie will automatically expire if you do not visit the
Mondaq website (or its affiliate sites) for 12 months. We also use the cookie to
personalise a user's experience of the site (for example to show information
specific to a user's region). As the Mondaq sites are fully personalised and
cookies are essential to its core technology the site will function
unpredictably with browsers that do not support cookies - or where cookies are
disabled (in these circumstances we advise you to attempt to locate the
information you require elsewhere on the web). However if you are concerned
about the presence of a Mondaq cookie on your machine you can also choose to
expire the cookie immediately (remove it) by selecting the 'Log Off' menu option
as the last thing you do when you use the site.

Some of our business partners may use cookies on our site (for example,
advertisers). However, we have no access to or control over these cookies and we
are not aware of any at present that do so.

Log Files

We use IP addresses to analyse trends, administer the site, track movement,
and gather broad demographic information for aggregate use. IP addresses are not
linked to personally identifiable information.

Links

This web site contains links to other sites. Please be aware that Mondaq (or
its affiliate sites) are not responsible for the privacy practices of such other
sites. We encourage our users to be aware when they leave our site and to read
the privacy statements of these third party sites. This privacy statement
applies solely to information collected by this Web site.

Surveys & Contests

From time-to-time our site requests information from users via surveys or
contests. Participation in these surveys or contests is completely voluntary and
the user therefore has a choice whether or not to disclose any information
requested. Information requested may include contact information (such as name
and delivery address), and demographic information (such as postcode, age
level). Contact information will be used to notify the winners and award prizes.
Survey information will be used for purposes of monitoring or improving the
functionality of the site.

Mail-A-Friend

If a user elects to use our referral service for informing a friend about our
site, we ask them for the friend’s name and email address. Mondaq stores this
information and may contact the friend to invite them to register with Mondaq,
but they will not be contacted more than once. The friend may contact Mondaq to
request the removal of this information from our database.

Security

This website takes every reasonable precaution to protect our users’
information. When users submit sensitive information via the website, your
information is protected using firewalls and other security technology. If you
have any questions about the security at our website, you can send an email to
webmaster@mondaq.com.

Correcting/Updating Personal Information

If a user’s personally identifiable information changes (such as postcode),
or if a user no longer desires our service, we will endeavour to provide a way
to correct, update or remove that user’s personal data provided to us. This can
usually be done at the “Your Profile” page or by sending an email to EditorialAdvisor@mondaq.com.

Notification of Changes

If we decide to change our Terms & Conditions or Privacy Policy, we will
post those changes on our site so our users are always aware of what information
we collect, how we use it, and under what circumstances, if any, we disclose it.
If at any point we decide to use personally identifiable information in a manner
different from that stated at the time it was collected, we will notify users by
way of an email. Users will have a choice as to whether or not we use their
information in this different manner. We will use information in accordance with
the privacy policy under which the information was collected.

How to contact Mondaq

If for some reason you believe Mondaq Ltd. has not adhered to these
principles, please notify us by e-mail at problems@mondaq.com and we will use
commercially reasonable efforts to determine and correct the problem promptly.